Non-vitamin K oral anticoagulants versus vitamin K antagonists in the treatment of venous thromboembolic disease

Abstract

Introduction: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the western world. The approval of non-vitamin K oral anticoagulants (NOACs) as antithrombotic alternatives to vitamin K antagonists (VKAs) has offered more treatment options to physicians for the prevention of VTE recurrence, fatal pulmonary embolism (PE) and long-term complications. Four NOACs (dabigatran, rivaroxaban, apixaban and edoxaban) that have been approved for the treatment of acute VTE following large phase III trials, where NOACs demonstrated similar efficacy and superior safety profile compared to VKAs.

Areas covered: The purpose of this review article is to summarise current knowledge of oral anticoagulation for the treatment of acute VTE and to compare NOACs with VKAs, highlighting the factors that might influence the decisions of physicians. Data for this article were obtained through a search of PubMed for trials comparing NOACs with VKAs in acute VTE setting and articles or analyses that interpreted results from these trials.

Expert opinion: The NOACs have changed clinical practice regarding oral anticoagulation for acute VTE. Despite their advantages, 'grey zones' still remain and more studies are needed to provide evidence and confirm the superiority (or at least non-inferiority) of NOACs over VKAs. Real world data might give additional insights.

Keywords: Non-vitamin K oral anticoagulants; Venous Thromboembolism; apixaban; cost-effectiveness; dabigatran; deep vein thrombosis; edoxaban; pulmonary embolism; rivaroxaban; vitamin K antagonists; warfarin.